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Therapeutic, Educational And Employment Services for Children with Intellectual Disability in Pakistan.

Byline: Humara Bano and Nyla Anjum

In Pakistan, approximately 2.49% % of total population has disability and 14% of this disabled population had intellectual disabilities. At the time of independence 1947, there were no special education schools for children with intellectual disability in Pakistan. History of working with this population started in 1950 s at individual level. Success of individual efforts motivated and encouraged private sector to get involved in this noble task. The first government initiative for the education of special children can be traced back to the report of National Commission on Education, 1959, which recommended vocational education for children and adults with intellectual disabilities. The movement spread all over the country but slowly.

1980-1990 is considered boom period in the history of prevention, treatment, education and rehabilitation for children with disabilities and now Pakistan is moving towards inclusive education and social inclusion through employment opportunities for children with intellectual disabilities. The focus of this study is to review therapeutic, educational and employment services for children and adult with intellectual disabilities in Pakistan during last fifty years. This study will also describe legal infrastructure of services delivery for children with intellectual disabilities in Pakistan.

Key words: Intellectual Disability, Therapeutic Services, Employment Services

INTRODUCTION

Islamic Republic of Pakistan is always occupied with security threats from its western border, faced tension on Afghan border from last thirty years and now is recognized as centre for war against terrorism. In the atmosphere of such insecurity, low literacy rate and low economic growth, it is praiseworthy that Children with Intellectual Disability are not lagged behind. Since its creation in 1947 uptill 2012, just in 65 years, Pakistan possesses a brilliant record of services provided in the field of intellectual disability. Now children with intellectual disability are not treated on charity basis but they have a right to education and employment. These rights are not only documented in policies but can be observed in educational institutions, and work place.

Objectives of the study

The study is conducted to review therapeutic, educational and employment services for children with intellectual disability in Pakistan.

Questions of the study

The study was conducted to answer following questions

1. What are constitutional and legal constrains for persons with disability in Pakistan?

2. What therapeutic services are provided to children with intellectual disability in Pakistan?

3. What educational services are provided to children with intellectual disability in Pakistan?

4. What employment services are provided to children with intellectual disability in Pakistan?

METHOD

This study is qualitative in nature. Literature regarding this topic was reviewed. On the basis of reviewed literature this theoretical research paper is organized in four sections:

* Constitutional and legal constrains for persons with disability in Pakistan

* Therapeutic services for children with intellectual disability in Pakistan

* Educational services for children with intellectual disability in Pakistan

* Employment services for children with intellectual disability in Pakistan

Constitutional and Legal Constrains

Constitutional and legal obligations for individuals with intellectual disability cannot be described apart from other disabilities. So, general reforms and acts in this section are documented jointly and particular reforms and activities with special reference to intellectual disability are described and focused in details.

The constitution of the Islamic Republic of Pakistan 1973, enjoins on the State to alleviate the sufferings of all citizens, irrespective of sex, caste, creed or race. According to Rules of Business 1973, the Ministry of Social Welfare and Special Education's overall mandate includes national planning and coordination in the field of social welfare, dealings and agreements with other countries and international organizations on this subject, Charitable Endowments, Grant-in-Aid to voluntary social welfare agencies, social welfare research, training and education of disabled and protection of neglected children. The Ministry carries out its mandate through various attached departments, autonomous bodies and projects.

At the international scenario, Pakistan is signatory of a number of international instruments, which call for promoting the cause of this segment of society through just and rights based approach. Pakistan, through its meagre resources is endeavouring to mitigate sufferings of People with Disabilities (PWD).

The first government initiative for the education of special children can be traced in the report of National Commission on Education (1959). It recommended vocational education for children and adults with mental retardation now called intellectual disability (Stodden, 2002).

In the Education Policy 1972-80, for the first time, funds were allocated to special education.

The declaration by the United Nations of 1983-1992, as the "Decade of the Disabled" brought into focus the long existing need to formulate a national strategy to tackle the problems of the disabled and handicapped of all categories and descriptions. The National Policy for Rehabilitation of the Disabled was thus conceived in December 1986 by the Ministry of Health, Special Education and Social Welfare, and this was in fact the first policy on special education in Pakistan.

A door of self reliance and empowerment opened with the promulgation of "The Disabled Persons Employment and Rehabilitation Ordinances" in 1981, "National Council for the Rehabilitation of Disabled Persons" (NCRDP) was established in 1982 and "Provincial Councils for Rehabilitation of Disabled Persons" (PCRDP) were also established in the four provinces of the country and one percent quota was allotted for employment to PWD in all government departments and private departments having one hundred employees. Directorate General of Special Education (DGSE) was established in 1985, with mission of policy formulation, planning, legislation and implementation of programs concerning education, training, and rehabilitation of PWD. "National Institute of Special Education (NISE) was established in 1986, with aims of organizing seminars, workshops, and training courses for teachers, parents and other personnel related to the field.

In 1988, "National Trust for the Disabled" (NTD) was established under the Federal Government to ensure efficient, effective and speedy planning, implementation and coordination of services for diagnosis, assessment, education, care treatment, job placement and rehabilitation of PWD. Vocational Rehabilitation and Employment of Disabled Persons with Community Participation (VREDP) was launched, with the technical and financial assistance of "International Labour Organization" (ILO) to establish a cost effective, non- institutional, community based rehabilitation program to reach a larger number of disabled persons.

National Policy for PWD was approved in 2002. The overall vision of the National policy is determined in keeping with Islamic way of life to provide by 2025 an environment that would allow full realization of the potential of PWD through their inclusive mainstreaming and providing them full support of the government, private sector and civil society. A significant mile stone in this regard was crossed when the Ministry of Education and Social welfare was separated from Ministry of Women Development and conceived its independent status in 2004.

National Plan of Action 2006, include early intervention, assessment, medical treatment, education and training, vocational training, employment and rehabilitation, research and development, advocacy and mass awareness, sports and recreation, barrier free buildings, park and public places and strengthening of institutions.

Pakistan Persons with Disabilities Act 2008 and the Persons with Disabilities (equal opportunities, protection of rights and full participation) Act 2008 are land mark achievements in ongoing endeavors of Pakistan for PWD.

All these constitutional and legal reforms created an acceptable atmosphere for PWD. Media campaigns, availability of institutions and involvement of non government organizations have the credit to change the scenario in Pakistan regarding PWD that directly affect children with intellectual disability which was the most ignored area due to some supernatural beliefs in Pakistani society and misconceptions attached to this condition. Parents and community has accepted intellectual disability as a type of disability and acceptance is growing to accept it as a social phenomenon. Focus on mother health camping, medical awareness, increase in medical services in remote areas helped to make better nutrition conditions and reduce risk factors for intellectual disability.

Therapeutic Services

Most symptoms of intellectual disability such as Down syndrome, hydrocephaly and microcephaly are observed and identified at birth and most hospitals in Pakistan currently have an advanced system of assessing newborns for these conditions. Early diagnosis leads towards rehabilitation and educational services. Educational institutions have linked with assessment and diagnostic centres working in private and public sectors. Some educational institutions have their own assessment procedures. This helped to set educational programs and implementation of The Individualized Educational Plan (IEP). Standardised tools are used for diagnostic purpose such as Portage Guide, Wechsler Intelligence Scale for Children (WISC-R), Raven Progressive Metrics and Self assessment tools.

Other therapeutic services along with Medical treatment are: Social skills training, Speech therapy, Play therapy, Group therapy and Music therapy.

Physio therapy addresses the sensory difficulties of children with intellectual disabilities. It helps them to develop the gross motor skills required for everyday activities. It also promotes flexibility and stimulates learning abilities through sensory integration activities. In order to be successful in life, everyone needs to master certain social skills, including people with intellectual disability. These skills enable people to function well in any social situation (work, school, and interpersonal relationships); but, these skills tend to be lacking in people with intellectual disabilities. In Pakistan social skills are taught to children with intellectual disability through verbal instructions and modelling. According to Iqbal (2011), video instruction has significant effects in learning of socialization skills for children with moderate mental retardation.

There is strong effort from some researchers to introduce and to implement video instructions in training program with general following social skills: the ability to understand and respect others, shared social rules and acceptable ways to interact with one another, to make eye contact and physical contact with another person (e.g. a handshake versus a hug), knowing how to politely start and stop conversations, knowing how to make small talk, and understanding how to notice and respond to non-verbal body language.

Good social skills also require behavioural management skills. For example, impulses must be kept under control across a wide variety of social situations. Adequate self-care and grooming skills are also demonstrated. People with intellectual disabilities often need to be explicitly taught self-management skills such as refraining from talking out of turn, and speaking at an appropriate volume when conversing. They also need to learn the importance of following rules and complying with social conventions, such as waiting in line for different jobs.

Educational Services

History of working with individuals with intellectual disabilities has its roots in private sector. At the time of creation of Pakistan in 1947, there was not a single institution in Pakistan for children with intellectual disabilities. The first NGOs concerned with individuals with intellectual disabilities in Pakistan were initiated largely by the efforts of fathers having mentally retarded children in collaboration with a few other concerned people. The first pioneer of this field A.S. Muslim took first initiative in 1959 when he wrote a letter in the major Urdu and English newspapers, stating that he had a mentally retarded child and did not know where to find help. Replies poured in from far and near, and in 1960 he founded the Society for Children in Need of Special Attention (SCINOSA), with an elected governing body of two physicians, a lawyer, a social worker, a retired senior civil servant and a businessman, three of them being fathers of disabled children (Miles,1993).

In 1962, a day care center was opened in Karachi for individuals with intellectual disability. West Pakistan Society for the Welfare of Mentally Retarded Children was formed in the same year and The Centre Amin Maktab for Children with Mental Retardation was also opened in Lahore in 1962. During the 1960s, it was realized that services should move 'into the community', and this trend began to influence Pakistan in the 1970s. Pakistan's first conference of rehabilitation experts (1975) discussed many approaches, taking into account the economic resources of the country, the importance of the traditional network of mutual support in families, and the idea that handicap is socially constructed and so needs social solutions( Miles 1992 and Pakistan Society, 1993).

Availability of schools became better with the passage of time. In 1980, 1 school was available for 48,571 individuals; in 1990, the ratio is 1 school for 12,133 children and in 2000, this was 1 school for 11,340 in Pakistan. Province wise availability is, in Punjab, in 1980, 1 school fore 45325 children, in Sindh, 1 school for 19550 children, in NWFP no school was available for 1, 08,800 children, in Balochistan, no school was available for population of 45,500 and even no school was available in Islamabad for 4080 students. In the year 1990, 1 school was available for 26582 in Punjab; in Sindh 1 school was available for 5367 children, in NWFP, 1school for 12133 children, in Baluchistan, 1 school for 22750 and in Islamabad 1 school for 18200. In 2000, in Punjab 1 school for 22611, 1 school for 5163 children, 1 school for 1257, 1 school for 18333 and 1 school 16500.( Khatoon, 2003). Number of students with mental retardation in special school was 756 in 1980, 3456 in 1990, and 7467 in 2000 in Pakistan.

Teacher training program was started by Allama Iqbal Open University in 1988, Karachi University in 1989 and in University of the Punjab, in 1991.

In 1947, there were no schools for the treatment of mental retardation in Sindh. During next 23 years 1947-70, three schools were established by NGOs. Till 1970, there was no contribution of federal government or provincial government during 1971-1980, provincial government established three more schools and NGOs established two schools. During the decade 1981-90 thirty schools were added and by the 1990 total number of schools for children with mental retardation in Sindh rose to 38, out of these 38 centers, provincial government established 20 centers. During 1991-2000, eleven new schools were added, out of which 8 were established by NGOs.

Educational services have been successfully moved towards inclusive education where individuals with intellectual disability live and learn in a natural, real-world environment and encounter many people who are different from them, learn to notice and adjust to these differences. This 'real-world' preparation later serves to promote their ability to live and work comfortably within their communities. As each child has different goals, abilities, and needs, there is no single best setting for all children. Parents and educators should realistically appraise the learning environments and resources available in their communities and make a selection that best matches the child's needs and circumstances. Furthermore, this decision should be re-evaluated periodically as the child's needs and circumstances change over time.

Typically people with intellectual disabilities do best in learning environments where visual aids are used as much as possible such as charts, pictures, and graphs. These visual tools are also useful for helping students to understand what behaviours are expected of them. Individuals with intellectual disability require immediate feedback in order to make a connection between their answers, behaviours, or questions and the teacher's responses. A delay in providing this immediate feedback may disrupt the formation of a connection between cause and effect in the student's mind, and the learning opportunity may be missed.

Employment Services

Children with disabilities can get admission in general vocational institutes. Special quota is allotted to increase their participation. NGOs sector is very strong in this regards. They provided free vocational training with reasonable stipends and free pick and drop facilities.

Historically, in the world, people with intellectual disabilities had a chance to perform only those jobs that were especially introduced or designed for this population. In Pakistan, people with intellectual disabilities usually performed non paid work. They were not hired for any formal or informal job. Employment of individuals with intellectual disability demands fully nested, healthy coordination of family, school and work place. There are some missing elements, however situation is amiable. Now families of individual with disabilities have started to understand the needs of their children and acknowledge their abilities. They have strong wish to make their children financially independent. Now families have expectations and demands from schools and therapists to train their children in this regard.

Today, job oriented skills are taught to individuals with intellectual disabilities with the consultation of family members and according to interest and ability level of children. Children are also encouraged to express their own will. Performance at work place must be evaluated but this aspect is still being ignored in Pakistan. Employers of people with intellectual disabilities have noted that these employees have proven to be punctual, reliable, and dependable. People with intellectual disabilities have successfully fulfilled the job responsibilities in a great variety of vocations; e.g., factory workers, machinists, automotive detailing, assembly line, furniture refinishing, home maintenance, laundry workers, and clerks (mail clerks, office clerks, retail clerks, and data entry). There is need to accept the above mentioned qualities of individual with disabilities and give them a chance to enter the job space. Rehabilitation institutions should focus on vocational training.

The skills include khadi (cloth making) art and craft, knitting, embroidery, stitching, tailoring and candle making. Now awareness is being increased and indigenous experts emphasise on including other areas like Computer skills, Mechanical task, Technical task, Helper, Photostat machines, Petrol pump/ CNG station, Telephone booth operator, Gardner, Sheaf, Sales man, Shoe making, Textile industry, and Carpenter. Many vocational and training institutes have offered them paid jobs in the same institution after completing their training and education. Some such individuals are engaged in small businesses with their fathers. Loan schemes on minimum mark up have been launched to help them to establish their own business. Participation of individuals with disabilities residing in rural areas is encouraged and supported.

Institutions involved in this effort are Federal Government, Provincial Government, District Government, Non Government Organizations, Chamber of Commerce and Industry, Small and Medium Enterprises SMEDA), First Women Bank, Khushali Bank, First Micro Credit Bank.

Individuals with disability require different levels of support for employment such as occupational, physical, vocational and social training. The need for these facilities is recognized but not practically implemented in Pakistan. So there is a need of such training programs that can help to teach important job skills.

Impact of all these services is observable in daily and community settings of individuals with intellectual disabilities. Now this population is not restricted to their homes or shrines but can reside within their community and enjoy facilities that others may have. There is a need of collaborative alliance between persons with an intellectual disability, his or her family members, and an interdisciplinary team of professionals. Accordingly, psychologists and other behavioural specialists, health care providers (nurses, doctors) speech and occupational therapists, educational and skills training specialists, service coordination specialists (case managers), and social workers are just a few of the professionals who are working not in all institutions but in noticeable institutions.

CONCLUSION

The review of the study reveals that various services provided to children with intellectual disability are satisfactory. The media has played a vital role in developing positive acceptance among the parents about their children with intellectual disabilities. Educational services are better now and moving towards inclusive education. Employment services for persons with intellectual disabilities are still less paid at work places that require fully nested and healthy conditions.

RECOMMENDATIONS

Following recommendations are made to provide better services for persons with intellectual disabilities:

Therapeutic services must be provided free of cost to children with intellectual disabilities to make them independent and state must play its role in this regard.

Regular teachers training programs must focus the inclusion of these persons.

Employment rules should be revised and salary structure for the persons with intellectual disabilities must be increased to such an extent that they may live an independent life.

REFERENCES

Asia- Pacific Development Center on disability. ( 2009) retrieved May 28, 2011, from http://www.unescap.org/ESID/psis/disability/publications/glance/Disability_at_a _Glance.pdf

Khatoon, A. A. (2003). A historical and evaluative study of special education in Pakistan. Unpublished doctoral dissertation, University of Karachi, Pakistan. Pakistan Society for the Welfare of Mentally Retarded Children. (1993). Introductory Brochure, Lahore.

Population Censes Organization. (2004). Pakistan Statistical Pocket Book. Government of Pakistan. Retrieved May 20, 2007, from http://www.apcdproject.org/cuontryprofile/Pakistan/Pakistan- current.html#current5.

Miles, M. (1993). Mental handicap services: practical trends in Pakistan, European journal of Special Needs Education, 8, 45-58.

Miles, M. (1998). Development of community based rehabilitation in Pakistan: Bringing mental handicap in to focus. International Journal of Development, Disability and Education, 45, 431-448.

Ministry of Women Development, Social Welfare and Special Education. (2002). National policy for the education and rehabilitation of the disabled. Islamabad: Government of Pakistan.

Iqbal, S. (2011). The Effects of Video Instructions on Socialization of Students with Mental

Retardation. Un-published doctoral dissertation, University of the Punjab, Pakistan.
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Publication:New Horizons
Geographic Code:9PAKI
Date:Jun 30, 2013
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